USPSTF: Screen for Family Violence

Action Points

The USPSTF found that there is adequate evidence that available screening instruments can identify current and past abuse or increased risk for abuse and recommends that clinicians screen women of childbearing age for IPV, such as domestic violence. This recommendation applies to women who do not have signs or symptoms of abuse. The USPSTF in addition concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening all elderly or vulnerable adults for abuse and neglect.

The USPSTF also recommends that clinicians provide or refer women who screen positive to intervention services.

Clinicians should routinely screen women of childbearing age for intimate partner violence, including those who don't appear to be obvious abuse victims, the U.S. Preventive Services Task Force recommended.

After reviewing the literature on screening for domestic violence, the USPSTF concluded that such universal screening by physicians, followed by interventions for those screening positive, would be at least moderately beneficial on balance.

A variety of interventions, including counseling and mentoring, home visits, information cards, and referrals to other services, have received support from randomized trials involving premenopausal women, the panel found.

The USPSTF assigned its conclusions a grade of B, meaning that there is either a high certainty of a moderate benefit or a moderate certainty of substantial benefit from providing the recommended services.

The new recommendations -- published online in Annals of Internal Medicine -- updated a previous USPSTF review in 2004, when the panel found too little solid data to support recommendations on screening and intervention.

However, the panel said it still could not make recommendations for intimate partner violence (IPV) screening in the elderly, noting a lack of research available for review. Likewise, the effectiveness of interventions for women beyond menopause but not yet elderly could not be determined.

About 25% of women and 14% of men reported experiencing the most severe IPV. The panel called IPV a "significant and largely unaddressed public health problem."

Overall, studies reviewed by the USPSTF indicated that nearly 31% of women and 26% of men report IPV, but the panel concluded that these are probably underestimates.

The panel said the latest review found that intervention -- including the use of digital devices -- reduced IPV against girls and women of childbearing age. Patients reported preferring computerized screening, particularly audio questionnaires that were hard for abusive partners to detect.

USPSTF reported searching randomized, controlled trials and other systematic reviews for the benefits and harms of screening adult women of childbearing age and elderly and vulnerable adults.

The panel reviewed data on 14 screening tests, most of which sought to uncover current or past IPV, not measure risk factors for future abuse.

Six tools that ranked highest for sensitivity and specificity for identifying IPV were:

HITS (Hurt, Insult, Threaten, Scream) (English and Spanish versions)

OAS/OVAT (Ongoing Abuse Screen/Ongoing Violence Assessment Tool)

STaT (Slapped, Threatened, and Throw)

HARK (Humiliation, Afraid, Rape, Kick)

CTQ-SF (Modified Childhood Trauma Questionnaire–Short Form)

WAST (Woman Abuse Screen Tool)

The panel lamented that less documentation about rates of abuse among non-institutionalized elderly or vulnerable adults was available. Nevertheless, rates between 2% to 25% have been documented.

Screening is complicated by a lack of tools and vagueness in how to screen the elderly, the panel indicated. "Physician discomfort" was cited as another barrier.

"Good-quality randomized, controlled trials focusing on both screening and interventions are needed," the USPSTF said.

Screening and intervention for family violence is similarly endorsed by the American Academy of Family Physicians, the American College of Emergency Physicians (ACEP), the American Academy of Pediatrics (AAP), and the Emergency Nurses Association (ENA).

The work had no commercial funding. Moyer and other co-authors of the recommendations declared they had no relevant financial relationships.

Reviewed by Zalman S. Agus, MD Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner